Jenda: A Journal of Culture and African Women Studies (2001)
ISSN: 1530-5686
WOMEN AND AIDS IN SOUTHERN AFRICA: THE CASE OF ZIMBABWE AND ITS POLICY IMPLICATIONS
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Jenda: A Journal of Culture and African Women Studies (2001) ISSN: 1530-5686 WOMEN AND AIDS IN SOUTHERN AFRICA: THE CASE OF ZIMBABWE AND ITS POLICY IMPLICATIONS |
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Gladys Bindura Mutangadura
Since the late 1980s, HIV/AIDS is having devastating effects on Africa. According to the June 2000 report of the Joint UN Program on HIV/AIDS (UNAIDS), about 71% of the estimated 34.3 million people with HIV/AIDS live in sub-Saharan Africa. Twenty- nine countries in sub-Saharan Africa have an HIV prevalence of 2 percent or more. Southern Africa holds the majority of the world’s hard-hit countries. In Botswana, Namibia, Swaziland and Zimbabwe, current estimates show that between 20% and 26% of people aged 15-49 are living with HIV or AIDS. In countries hard hit by the pandemic, morbidity and mortality have risen and are expected to continue to rise. The major route of AIDS in Sub- Saharan Africa is heterosexual intercourse, estimated to account for 93 percent of all adult cases, followed by blood transfusions, and vertical transmission of the AIDS virus from mother to fetus.
At the global level, 46% of the 34.3 million people currently living with HIV/AIDS are women (UNAIDS 2000). However the trend in the proportion of females infected with HIV/AIDS to the total adult population infected with HIV/AIDS has increased from 41% in 1997 to 46% in 1999 indicating a narrowing of the male-to-female infection gap. The proportion of adult female deaths to the total number of deaths due to HIV/AIDS has also increased from 46% in 1997 to 52% in 1999. In Zimbabwe, the national adult HIV rate is 25.8%, but in terms of distribution between men and women, HIV infection is roughly equal. However women are infected by HIV/AIDS at a younger age with HIV rates showing a peak in the 19-29 year old age group, in men the peak is 30-39 year old in Zimbabwe (NACP,1998). Since they get infected at a younger age, the death toll for women is high in their productive age group.
Women are especially vulnerable to HIV/AIDS because they have more vulnerable employment status dependent on labour intensive activities, lower incomes, least access to formal social security and least entitlements to or ownership of assets and savings. They are physiologically at high risk of being infected by HIV/AIDS, research indicates that the risk of HIV infection is 2 to 4 times higher for women than men during unprotected intercourse because of the larger surface areas exposed to contact (NACP, 1998, De Bruyn, 1992). More than 50 percent of the women in sub Saharan Africa live in rural areas where services are often inaccessible and unaffordable. It has already been recognized that the subordination of women to men creates a highly unfavorable environment for preventing HIV infection especially when major prevention strategies recommended are abstinence, mutual fidelity or use of male condom, none of which are under the control of women. New products, such as microbicides, have the potential to strengthen HIV prevention efforts in women by allowing women to be able to control its use.
Women exhibit certain nurturing and allocative behaviors that enhance the food and nutrition security of the entire household and of children in particular (Haddad, 1999). But what happens to the household when this woman eventually falls ill and dies? Key questions which implementers are interested in include: What are the impacts of adult female mortality? What is the role of inter-household support in alleviating the impacts? What are the priority areas for policy and program formulation? This paper describes the welfare impacts of adult female mortality at household levels using a study done in Zimbabwe as the main example. The study in Zimbabwe was conducted on a total sample of 215 households, which included 101 households from the urban site, and 114 households from the rural site. The sample of 215 households was purposively selected to include households fostering child orphans (aged 18 years and younger) whose mother had died below the age of 50 within the past five years. A structured questionnaire was used to obtain in depth information on the household-specific impacts of adult female death. A household in this paper is defined as a group of persons who are living with the orphans in the same dwelling and are dining together for at least three of the twelve months before the survey. Only about 30 percent of the orphans were in the original households where they were living with their mother before she died. Seventy percent of the orphans had moved to join new households. The respondents of the survey interviews were the surviving children, husband, and the relatives who were now fostering the orphans such as grandmother, elder brother or sister, aunt or uncle of the orphans. The currently adopted household coping responses and the available formal and informal support mechanisms utilized by households are discussed. In the light of these findings, emerging policy and program implications are suggested which can help policy makers and program planners strengthen the capacities of communities and surviving households.
The leading reported causes of death of the adult female in the study of 215 households were childbirth, coughing/TB, HIV/AIDS, malaria, diarrhea, high blood pressure and meningitis. Tuberculosis and diarrhea are primary manifestations of HIV/AIDS, while meningitis and malaria mortality can be HIV/AIDS related. These results imply that the leading cause of death in adult females in this purposively selected sample was HIV/AIDS related. Adetunji (1997), in the studies he reviewed on the mortality impact of HIV/AIDS in sub-Saharan Africa, also found that HIV/AIDS was the leading cause of mortality for women, aged 15 to 59, in Tanzania.
The strength of the household in managing the impacts of the loss of an adult female in the household depends on the economic asset base. Households that have higher incomes or better alternative resources are better able to cope with the impact of an income shocks such as HIV/AIDS (Rugalema, 1999). In this study, households were asked whether they had sold or lost an asset due to the death of the adult female. Overall, 24% of the surveyed households indicated that they had sold an asset to cope with the death of the adult female, with a larger percentage in rural areas. The most commonly sold items were cattle, goats, furniture, clothes, televisions, poultry and wardrobe. The dominant reasons for selling assets were to buy food, meet funeral costs and pay school fees. Based on these results one can infer that assets play an important role in managing income shocks related to the death of an adult female. However, in the case where productive assets are sold such as livestock, it is important to note that such families may be deprived of future ability to sustain production.
The leading category of foster parents when the adult female dies in the Zimbabwe study was grandmother, accounting for 52%, followed by related foster parent (such as aunt, elder brother or sister or uncle), 36%, surviving husband, 10%, and child headed household 2%. The fact that grandmothers are leading in fostering orphans indicates that mitigation programs should be sensitive to this gender and age issue. The socio-economic characteristics of the households interviewed in the study reveal that more than 70% of the interviewed foster household heads relied on informal sources of income such as agriculture, food and clothes vending, knitting and sewing. However, informal sector jobs are generally low paying, with 75% of the whole sample indicating their informal incomes to be US $20 per month or less. Research in a western Tanzania district (Rugalema 1999) found the elderly who had lost adult children to HIV/AIDS were much poorer and hence more insecure than in the pre-HIV/AIDS period. About 25% of these elderly had psychological problems such as crying spells (Rugalema 1999). These problems can have serious and often devastating impacts on the orphan’s welfare and potential to break out of the poverty cycle.
When a household experiences an adult female death, a child might be withdrawn from school to make up for the loss in income experienced by the adult or stop school because of lack of funds for school fees. In a study in Tanzania, Ainsworth found the death of woman aged 15-50 in a household to be negatively related with enrollments in the last 12 months of all children in that household while there was no association between enrollments and death of a man aged 15- 50. Ainsworth concludes that when a woman in the household dies, children are likely to replace that woman’s domestic roles in the short run. The study in Zimbabwe found that a total of 27 households (13% of interviewed households) had children who were unable to go to school after the death of the adult because of lack of money. Withdrawing children from school is a short-term strategy that has permanent effects that could make it difficult to reduce poverty in the longer term. Thus, there is need to provide assistance in the form of school fees to needy households to prevent a potential negative impact on human development.
Women are known as the gatekeepers of their household food security through the allocation of their (a) time in food production, preparation, distribution and marketing roles, and (b) income through sale of excess food or their involvement in formal or informal activities. Overwhelmingly, studies in developing countries show that women more than men spend more of their individual income on goods and labor time in activities which contribute to security of consumption for children and other household members while men tend to spend more of their individual income on personal goods (Haddad, 1999). In rural Africa women play a major role in agricultural production, with women accounting for 70% to 80% of the food (Neema 1999, Quisumbing et al, 1998). Affected female-headed farming households or households heavily relying on female-dominated agricultural production may suffer severely in the short run through AIDS-related production losses in food and income (Neema 1999). In the study in Zimbabwe, households were asked how their consumption of a particular food commodity had changed since the death of the adult female. Households indicated they had a decreased consumption in most of the food commodities including maize meal, meat, cooking-oil, bread, sugar, milk and eggs. However, caution needs to be exercised when interpreting the decrease in food consumption because it is difficult to separate the impact of adult female death from impacts caused by rising inflation. Nevertheless, it is important to note that the food security situation of the surviving family was poorer after the death of the adult female. Thus the loss of an adult female in a household is likely to lead to increased poverty and food insecurity in affected households.
Availability and accessibility of informal social support mechanisms is crucial for successful recovery from a death of an adult female in the household. Informal social support mechanisms refer to the inter-household relationships between the household and community members, friends, relatives, and neighbors. In times of stress, households usually resort to these relationships for help on the basis of trust and reciprocity. Traditionally it is assumed that the extended family, and the community at large assist the household socially, economically, psychologically and emotionally. Literature reveals that households experiencing income stress due to HIV/AIDS, send their children to live with relatives: Sauerborn et al (1996) in rural Burkina Faso; Barnett and Blakie (1992) in Uganda; Lwihula (1999 ) in the Kagera region, Tanzania; Rugalema (1999); Drinkwater (1993) in Zambia; and Mutangadura and Webb (1999) in Zambia. Relatives will then be responsible for meeting the children’s food requirements. In the Zimbabwe study, households were asked to indicate the role played by the extended family and the community in helping affected households cope with the income shock. The results show 46% and 51% of surveyed households in urban and rural areas, respectively, had asked for some help from relatives, friends and neighbors within the last 12 months. The help sought was mainly in the form of food and money. However, help from relatives and friends is not easily obtainable, as reported by more than 95% of the households. The main reasons community help was not forthcoming were reported to be inflation, lack of money—because of high unemployment and personal overcommitment (everyone is being affected by the high morbidity and mortality because of the HIV/AIDS epidemic). The research revealed that the community, per se, is failing to help households in need, and if they do, the main form of help is providing food. This implies that the community needs external help in order to help households in need.
Very few households (5%) reported benefiting from informal social support schemes. The types of informal coping mechanisms reported by households were savings clubs, burial societies and church based support. Churches were reported to support orphans by providing food and school fees. However support from the church was reported to be limited to church members, to be irregular and to be inadequate. In the rural site, key informants and focus group participants revealed that some households were benefiting from grain-saving schemes. In these schemes, people in the community contribute labor, in the field of the chief or headman, and store the produce for households in need. Key informants revealed these grain-saving schemes have formed an important source of community support to affected households and can help mitigate the impacts of loss of an adult due to the HIV/AIDS epidemic if replicated to areas where they are presently non-functional. However, participants indicated there is need to provide fertilizer and seed to help ensure that the harvests are abundant and can be extended to help needy households.
The last ten years have seen a rapid economic downturn in Zimbabwe, largely provoked by crippling taxation, devaluation of the Zimbabwe dollar (ZWD) and high interest rates following the macroeconomic reforms implemented since 1991. As part of macroeconomic reforms, health and education fees were increased and enforced, lowering the affordability of these services to low-income households (Bassett et al 1997). Very limited forms of formal social protection exist to minimize the impacts of the death of an adult female on households in Zimbabwe. The main forms of public social protection measures that exist in Zimbabwe include public assistance, social development funds for health and school fees, a grain loan scheme and a child supplementary feeding program (Kaseke 1997). The primary public social support mechanisms which households reported they use were the Social Development Fund for school fees (SDF- fees), the Department of Social Welfare public assistance and the grain loan scheme. However, only a very small proportion of households (2%) were benefiting from these public support mechanisms. Focus group discussions and interviews with key informants revealed that support from the Department of Social Welfare was not forthcoming because the government no longer had funds to support its social support mechanisms.
The primary private formal social support mechanisms NGOs (Non governmental Organizations) operating in the areas include FOCUS and Plan International in the urban and rural sites and Christian Care, UNICEF and a Swedish organization operating only in the rural site. These NGOs provide primary school fees, food, clothing, seed and fertilizer and skills training. The participants rated virtually all the types of programs that the NGOs were operating to be helpful. The general constraint noted by participants was the irregularity and inadequacy of the help, especially food. Rural participants recommended that fertilizer and seed assistance should be continued because it empowered the household with a food source for the remainder of the year.
This study revealed that surviving children of a deceased adult female were more likely to be fostered by an elderly relative, usually a grandparent. A study (Foster 1998) of 340 orphans in Zimbabwe in 1995 also found that grandparents fostered nearly fifty percent of the orphans. However, the elderly have problems in taking care of young children because their capital, age, health and education constraints (Foster et al, 1998) limit their work opportunities. As HIV/AIDS continues to afflict young adults in Africa, it increasingly intensifies the vulnerability of the elderly who are left without social and economic support. Yet if these women have access to some form of income generation, studies have shown that women’s incomes are more strongly associated with improvements in children’s welfare (Quisumbing et al, 1998). It is, therefore, important to address the needs of elderly women when designing mitigation interventions to ensure that their constraints in raising young children are addressed. While it is not a new phenomenon that grandparents are fostering young children in Sub Saharan Africa, with the increase in death rates of young adults there has to be some concern since their death results in a loss of a source of remittance. There is need therefore to design a partial old age support package from the government, specifically targeted to the elderly who are in difficult situations such as fostering the grandchildren.
The leading reported cause of death of adult females HIV/AIDS related diseases; fewer died from childbirth. The relative importance of a cause of adult death is important for setting priorities in research and intervention (Adetunji, 1997). It is important that the governments’ long-term development strategies address the underlying problems that make adult females vulnerable to illness and deaths. Strategies should be aimed at empowering women through improved access to health, intensified HIV/AIDS awareness and prevention programs and improved access to education.
There were households with children who no longer attended school after the death of the mother. The major reason cited was lack of financial resources to pay for school fees. The proportion of children not going to school after the death of the mother was higher in secondary school going age. Children who grow up without adequate education are less socialized and less productive members of society. The lack of education will hamper their chances of finding formal sector employment and in a society, which increasingly requires educated and technically capable people; this lack of human capital will be a national constraint. There is, therefore, need to assist needy-orphaned children by providing school fees, particularly secondary school fees. By completing secondary education, most youths will have the educational background to be able to undertake skills training and enter the job market. However such a program need not be earmarked to orphans alone, but to children from poor households. In this regards targeting should also include poverty indicators.
The extended family is still the major source of care for surviving orphans. However the poorer the community and the more advanced the stage of the AIDS epidemic, the less likely the community is able to cope with the increase in number of orphans (McKerrow, 1998). The study in Zimbabwe revealed that extended families are then under severe pressure and fail to meet certain needs of orphans particularly school fees (due to lack of money) and the severe economic pressures. One of the main coping mechanisms adopted by foster households was informal business activities. There is need to explore ways of strengthening informal activities that have been reported to be most frequently used by households such as vending, agriculture, crafts and sewing/knitting. Increased informal sector activity can be a major route to fostering the informal mutual assistance schemes found in the communities. The level of output and earnings in the informal sector can be increased by enhancing its supply potential through policies aimed at improving access to financing, supportive regulatory policies, supportive infrastructure, removal of prohibitive by-laws hindering the operations of this informal sector, provision of micro-credit, training and disseminating information about appropriate technologies (Kurosaki and Sawada 1999; Raftopolous et al 1998; Kanji and Jazdowska 1993).
The grain-saving scheme has emerged to be one of the major important community social support mechanisms to needy households. It important to encourage replication of this scheme and help strengthen it through provision of seed and fertilizer. Hunter and Williamson (1998) emphasize that it is less expensive and more effective, in terms of social integration, to strengthen community capacities to care for orphans.
Very few households reported benefiting from other informal social support mechanisms. The types of informal coping mechanisms reported by households were savings clubs, burial societies and church based support. Church support, burial societies, rotating and savings clubs and women’s groups were rated to be effective types of informal support mechanisms to morbidity and mortality related income shocks. It is therefore important to explore ways to strengthen community capacities to cope with the impact of adult female deaths that can be obtained from burial societies, savings clubs, women’s clubs and churches. Hunter and Williamson (1998), emphasized that working through existing initiatives has many advantages including sustainability, community ownership, cost effectiveness and ease of replication.
Overall, policies which strengthen household’s coping strategies should be encouraged, but such policies should be seen as a complement to, and not a substitute for, efficient and equitable macro-economic policies and sustained growth in the formal sector of the economy. It is important that macro-economic policies securely embeds the need to sustain the welfare of the most vulnerable in society, by addressing inflation and ensuring that expenditures on social capital does not decrease. It is important that the government prioritizes the welfare of the poor and allocates resources towards it if progress in the country’s human development is to be achieved. Poverty alleviation strategies can only be successful where the macro-economic policies are supportive of the social policies (Raftopolous et a, 1998). Macro- economic policies that are required include those that foster economic growth, price stability, create an environment that promotes savings, create investments and employment, improve the purchasing power of the poor, reduce unproductive spending (such as military spending) and promote efficient spending on the social sectors: health and education.
Given the wide variety of interventions available, there is need for each government organization working on HIV/AIDS mitigation, to prioritize limited resources across the different intervention programs. For some government institutions, implementation of these recommendations involves integration of HIV/AIDS into already existing development programs. Existing agricultural research and extension programs can be reviewed to develop and promote technologies and extension methodologies that are appropriate to assist HIV/AIDS affected families. The Department of Social Welfare can integrate HIV/AIDS prevention, care, counseling and mitigation into their formal social support mechanisms, since HIV/AIDS is now a major form of idiosyncratic shock affecting households; this would also prevent future illnesses, deaths and poverty. Given the high death rates of young adults in these countries, the state organizations cannot do it alone. There is need for collaboration with other community organizations, development agencies and churches, if efforts to mitigate the impact of HIV/AIDS are to be successful. Private and community organizations need to network and identify the critical areas of need and prioritize their intervention programs.
In general, the impact of premature adult female death has a negative impact on the surviving children—notably shortage of food, lack of suitable shelter, and withdrawal of children from schools. The care of orphans will become one of the greatest challenges facing SubSaharan Africa as the HIV/AIDS epidemic continues to claim the lives of young adults. In the past the burden was often assumed by the extended family but unfortunately, as found in this paper, many people are now experiencing severe pressures from the poor economy and the increase in the number of people needing help. The study suggests there is need for external sources of assistance to undertake a broad range of programs that can improve the food security status of the household, improve the income generation capability of the household, empower orphans to become self reliant, strengthen community based social support mechanisms and empower women so that vulnerabilities that place them at risk of falling ill and dying can be minimized. The study emphasizes that it is critical for the state to play an active role in mobilizing resources by funding programs that have been identified, since improved human welfare is a necessary and primary condition for development. There is a need for government to embed human development more securely into the macroeconomic policies by prioritizing resources for poverty eradication and tackling inflation that has undermined the communities’ ability to protect households from the welfare impacts of the premature death of adult females.
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Copyright 2001 Africa Resource Center, Inc.
Citation Format
Mutangadura, Gladys Bindura (2001). WOMEN AND AIDS IN SOUTHERN AFRICA: THE CASE OF ZIMBABWE AND ITS POLICY IMPLICATIONS. Jenda: A Journal of Culture and African Women Studies: 1, 2.